Get Lced Form

Filling out the Lced Form online is an essential step for individuals seeking eligibility for ICF/MR level of care. This guide provides clear, step-by-step instructions to help you complete the form accurately and efficiently.

Follow the steps to complete the Lced Form online

1. Click the ‘Get Form’ button to access the form and open it in the online editor.
2. Enter the name of the individual requiring assistance in the designated field. Make sure to provide their full legal name.
3. Fill in the address of the individual. This should include the street address, city, state, and zip code.
4. Input the date of birth of the individual in the appropriate format (mm/dd/yyyy).
5. Select the responsible Medicaid district from a dropdown menu if available. This information is essential for processing.
6. Enter the Medicaid number (CIN) assigned to the individual.
7. Indicate the status by selecting the relevant option (620 or 621). Note that N/A for B2H Waiver should not be selected.
8. Provide the TABS ID if applicable.
9. Document the dates of any physical and pre-enrollment evaluations, including social and psychological assessments.
10. Answer all eligibility determination criteria questions truthfully, indicating 'YES' or 'NO' where required. Pay close attention to sections regarding diagnosis, health care needs, adaptive behavior deficits, and self-direction.
11. Once all sections are completed, review the document for accuracy and completeness.
12. Finally, save changes, and choose to download, print, or share the completed form as needed.

Complete your Lced Form online today to ensure timely processing of your eligibility for care.